目的: 通过对负重下肢全长正侧位X线片、股骨CT三维模型测量和分析股骨相关解剖参数,明确股骨解剖形态与矢状位力线的相关性,进而为膝关节假体安放和人工全膝关节置换术中精确恢复下肢力线提供帮助。方法: 招募10名健康志愿者,拍摄标准负重正侧位下肢全长X线片,确定冠状位、矢状位下肢力线及负重比例;收集60例行双下肢全长CTA患者影像学资料,通过Mimics软件对CT数据进行三维重建,结合二维图像和三维重建模型测量相关解剖参数,对数据采用K-S检验,并对所得数据进行分析。结果: (1)标准负重正位承重轴通过点位于股骨内侧髁45% 位点,侧位承重轴通过点位于股骨髁横轴线前44% 位点。(2)股骨三维模型测量股骨外翻角、股骨侧弓角、股骨前弓角、股骨近端偏心距、股骨颈前倾角、股骨颈干角、股骨长度分别为:4.55°±1.31°、0.41°±1.44°、9.54°±1.57°、37.04±4.74 mm、14.99°±7.52°、131.17°±7.23°、414.24±23.70 mm;股骨解剖轴与冠状面、矢状面的夹角为8.60±1.45、0.75±0.60、1.05±0.70、0.61±0.50,股骨力线与冠状面、矢状面的夹角为1.38°±0.93°、4.77°±1.65°。(3)相关分析显示股骨外翻角与股骨侧弓角呈显著正相关(r=0.552,P＜0.001),股骨外翻角与股骨近端偏心距呈正相关(r=0.502,P＜0.001),股骨前弓角与股骨颈前倾角呈正相关(r=0.543,P＜0.001);股骨力线和矢状面平面夹角与股骨前弓角呈显著正相关(r=0.823,P＜0.001),股骨力线和矢状面平面夹角与股骨颈前倾角呈正相关(r=0.424,P＜0.001) 。结论: 本研究发现,股骨力线与矢状面的夹角和股骨前弓角、股骨颈前倾角呈正相关,因此术前对股骨前弓角和股骨颈前倾角较大者,应相应调整截骨角度,有利于达到更加合理的力线对齐;本研究所述股骨解剖形态与股骨矢状位力线的相关关系对膝关节假体安放和全膝关节置换术具有重要参考意义。
Objective: To measure and analyze the anatomical parameters of the femur by measuring and analyzing the positive and lateral X-ray films of the full-length weight-bearing lower limbs and the three-dimensional model of the femur CT, and to clarify the correlation between the anatomical morphology of the femur and the sagittal force line, so as to provide help for the placement of knee prosthesis and the accurate recovery of the lower limb force line in total knee arthroplasty. Methods: Ten healthy volunteers were recruited. The full-length X-ray films of the lower limbs were taken to determine the coronal and sagittal force lines of the lower limbs and the weight-bearing ratio. The imaging data of 60 patients with full-length CTA of both lower limbs were collected. The CT data were reconstructed by Mimics software. The relevant anatomical parameters were measured by combining two-dimensional images and three-dimensional reconstruction models. The data were analyzed by K-S test. Results: (1)The standard weight-bearing positive bearing axis is located at 45% of the medial femoral condyle, and the lateral bearing axis is located at 44% before the transverse axis of the femoral condyle. (2) The femoral three-dimensional model measured femoral valgus angle, femoral lateral arch angle, femoral anterior arch angle, proximal femoral eccentricity, femoral neck anteversion, femoral neck shaft angle, and femoral length were 4.55°±1.31°, 0.41°±1.44°, 9.54°±1.57°, 37.04±4.74 mm, 14.99° ±7.52°, 131.17±7.23 °, and 414.24±23.70 mm, respectively; the angles between the femoral anatomical axis and the coronal and sagittal planes were 8.60±1.45, 0.75±0.60, 1.05±0.70 and 0.61±0.50, respectively; the angles between the femoral force line and the coronal and sagittal planes were 1.38°±0.93° and 4.77°±1.65°, respectively. (3)Correlation analysis showed that the femoral valgus angle was positively correlated with the femoral lateral arch angle (r=0.552, P＜0.001), the femoral valgus angle was positively correlated with the proximal femoral eccentricity (r=0.502, P＜0.001), and the femoral anterior arch angle was positively correlated with the femoral neck anteversion angle (r=0.543, P＜0.001); the angle between the femoral force line and the sagittal plane was positively correlated with the femoral anterior arch angle (r=0.823, P＜0.001), and the angle between the femoral force line and the sagittal plane was positively correlated with the femoral neck anteversion angle (r=0.424, P＜0.001). Conclusion: The angle between the femoral force line and the sagittal plane is closely related to the femoral anterior arch angle and the femoral neck anteversion angle. Therefore, if the femoral anterior arch angle and the femoral neck anteversion angle are larger before operation, the osteotomy angle should be adjusted accordingly, which is conducive to achieving a more reasonable alignment of the force line. The correlation between the anatomical morphology of the femur and the sagittal alignment of the femur described in this study has important reference significance for the placement of knee prosthesis and total knee arthroplasty.
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